Factors in the Hospital Experience Associated with Postpartum Breastfeeding Success

Facilitators and Barriers to Breastfeeding Among Veterans Using Veterans Affairs Maternity Care Benefits

INTRODUCTION

U.S. veterans of childbearing age represent one of the fastest growing populations using Veterans Affairs (VA) health care. The VA does not provide obstetric care directly but pays for VA-enrolled veterans to obtain outside obstetric care. The VA also provides maternity care coordination (MCC) services, including lactation support. Breastfeeding benefits mothers and babies; however, previous research shows that veteran mothers quit exclusive breastfeeding earlier than the American Academy of Pediatrics and World Health Organization recommendation of 6 months. This study aimed to understand facilitators and barriers to breastfeeding among a cohort of veterans who used VA maternity care benefits.

METHODS

Qualitative data from an open-ended question from a national sample of postpartum veterans using VA pregnancy benefits were coded using deductive and inductive content analysis within a matrix framework. Quantitative data were used to contextualize the responses.

RESULTS

Four themes emerged from the data: (1) impacts on health of baby/mother; (2) the ability to breastfeed; (3) early postnatal experiences breastfeeding; and (4) cost/convenience. Among those who responded to the open-ended breastfeeding question (329/669), most participants (n = 316; 96%) attempted breastfeeding their current baby. Respondents who did not initiate breastfeeding or who discontinued breastfeeding earlier than planned cited diverse reasons. These included low milk supply, poor latch, nipple pain, mental health factors, and low confidence in their ability to continue breastfeeding. Participants cited the MCC program as a facilitator to breastfeeding, and non-VA hospital experiences were mentioned as barriers.

CONCLUSION

Veterans in this cohort of 329 veterans who responded to an open-ended breastfeeding question wanted and attempted to breastfeed; however, barriers such as lactation challenges and unsupportive health care providers made it difficult to continue the practice. As the MCC program grows to include more lactation professionals, MCCs may address barriers such as lactation challenges and unsupportive non-VA health care providers. Further program development should focus on addressing these challenges prenatally.

Effect of Lactation Management Model on Breastfeeding Process After Cesarean: A Prospective Randomized Controlled Study

It is important to implement supportive programs to ensure mothers breast feed for the desired period, and infants are fed by only mother's milk. In the research, it was aimed at evaluating the effects of lactation management model on mothers' breastfeeding process following a caesarean section. Women who gave birth by planned cesarean delivery were divided into two groups, randomized control and experimental. Data collection was performed during gestation, first day after postpartum, pre-discharge, on the 9th day in a face to face interview, and in the form of monthly phone interviews up to 6 months. While the experimental group exercised the lactation management model, the control group received routine lactation practices in clinic. In the scores of Breastfeeding Charting System and Documentation Tool, a significant difference was found between the groups (p<0.001). 87.9% of the experimental group and 48.5% of the control group were determined to apply successful breast-feeding techniques. In addition, it was found that all of the experimental group breast fed 1 month longer than the control group, and for the first month, 90.9% of the experimental group and 78.8% of the control group breast fed with mother's milk only and a higher breastfeeding. Among in the experimental group, it was found that breastfeeding self-efficacy was higher, and breastfeeding techniques were accurate and successful and breastfeeding only and continuity rates were higher while breastfeeding related breast problems developed less frequently. Clinical Trials.gov Protocol Registration Number: NCT04593719.

Maternity care experiences and breastfeeding at discharge among Maryland WIC participants: A qualitative analysis

BACKGROUND

Breastfeeding imparts numerous health and social benefits for families. Barriers deter some individuals from breastfeeding. Rates are lower among certain populations, including participants of the federally funded Women, Infants, and Children's Program (WIC). Women, Infants, and Children's Program provides low-income pregnant and postpartum women and children under 5 with nutrition education, supplemental foods, breastfeeding education and support, and resource linkages. Investigation of WIC participants' hospital experiences and breastfeeding decisions is limited. We explore qualitative themes associated with breastfeeding-related hospital maternity care practices experienced by WIC participants.

METHODS

Thirty pregnant individuals intending to breastfeed were recruited at WIC clinics to complete in-depth interviews at 2 weeks, 3 months, and 6 months of postpartum. Using the Thematic Framework methodology, we analyzed data from the two-week interviews of 29 participants with respect to hospital breastfeeding experiences.

RESULTS

Fourteen participants were exclusively breastfeeding at discharge (EBFD). Fifteen were partially breastfeeding at discharge (PBFD). Differences between groups were found in hospital breastfeeding experiences, particularly in staff support. All participants EBFD reported positive breastfeeding-related staff experiences. Most participants PBFD reported limited and ineffective staff interaction, leading to formula introduction.

CONCLUSIONS

Individuals EBFD and those PBFD reported about the same rate of hospital breastfeeding difficulties, yet half introduced formula within the first few days postpartum. Results reiterate the importance of hospital staff support to breastfeeding exclusivity at 2-3 days postpartum. The challenges that these individuals faced may have been resolved through available, responsive, and effective intervention. Data-driven breastfeeding education programs for hospital health professionals are critical to affect patient breastfeeding outcomes.

Examining psychometric properties of the Iranian version of exclusive breastfeeding social support scale (EBFSS)

BACKGROUND

The exclusive breastfeeding (EBF) is undeniably proven significant in mothers' health and infants' growth and survival. Its persistence has many familial, social, and economical benefits. Social support is known to be an effective factor in EBF's success and sustainability. However, Exclusive breastfeeding social support (EBFSS) scale validity and reliability is not evaluated in Iran. This study aimed to determine the psychometric properties of EBFSS during postpartum period in Tabriz city, Iran.

METHODS

It is a cross-sectional study with descriptive survey method performed between March 2021 and August 2022. Psychometric properties were determined for the Persian version of EBFSS in six stages: translation process, evaluating content validity, face validity, construct validity, discriminant validity, and reliability. A group of experts (n = 10), followed by a group of women with EBF (n = 10), evaluated the instrument's items based on content and face validities, respectively. A cross-sectional study using the multi-stage cluster random sampling method on 348 women with EBF in the first four months after delivery was conducted to determine the construct validity. The internal consistency and repeatability (test-retest on 30 women, 2 weeks apart) were used to find out the reliability.

RESULTS

Content validity ratio (CVR), content validity index (CVI), and impact score were 0.98, 0.98, and 3.54 for EBFSS, respectively. This indicates a good content and face validity. Exploratory factor analysis (EFA) was performed on 16 items to examine the construct validity identified emotional, instrumental, and informational factors. These factors explained 59.26% of the cumulative variance. The fit indices (CFI = 0.98، TLI = 0.95، χ2/df = 4.20، RMSEA = 0.07 and SRMSEA = 0.05) confirmed the validity of the model in a confirmatory factor analysis (CFA). The internal consistency was examined through Cronbach's alpha and McDonald's omega coefficients that were 0.90 and 0.92, respectively. Finally, Repeatability and reproducibility were found 0.97 (95% CI: 0.92 to 0.99) using Intra-class correlation. This shows an appropriate reliability of the instrument.

CONCLUSIONS

The research findings indicate that the Persian version of the EBFSS has appropriate psychometric properties for evaluating the social support in Iranian women with EBF. This means healthcare providers can use it for screening social support in EBF. Researchers also can use it as a valid instrument.

Real-Time Breastfeeding Documentation: Timing of Breastfeeding Initiation and Outpatient Duration

BACKGROUND

Current breastfeeding guidelines promote initiating breastfeeding ≤1 h after birth to establish long-term breastfeeding. Previous studies dichotomized initiation to ≤1 h versus subsequent hours combined. There are limited data evaluating the effect of initiation in each subsequent hour on breastfeeding duration. Our objective was to evaluate the association between breastfeeding initiated at ≤1 h versus the subsequent 23 hours after birth and outpatient breastfeeding duration.

METHODS

In this retrospective cohort study, we analyzed real-time, discretely documented electronic health record (EHR) breastfeeding data for 3315 infants born at a university center and followed to age ≥12 mo at 27 university primary care clinics. The primary outcome was breastfeeding duration. The exposure variable was hour of breastfeeding initiation within 24 h postnatally. Data were analyzed by univariable and multivariable linear regression separately for infants born by vaginal versus cesarean delivery.

RESULTS

In adjusted models, initiating breastfeeding during each hour from age >1 to ≤6 h and during ages >6 to ≤24 h was not associated with decreased breastfeeding duration versus initiating breastfeeding at ≤1 h after birth for infants born via vaginal or cesarean delivery.

CONCLUSIONS

Delaying breastfeeding initiation to >1 to ≤24 h after birth is not associated with decreased breastfeeding duration compared with initiating breastfeeding at ≤1 h after birth. Integration of breastfeeding measures into inpatient and outpatient EHR discrete data fields may clarify best practices that support long-term breastfeeding as a public health imperative.

Relationship Between Feeders and Exclusive Breastfeeding and Mixed Feeding During the First Month of Life

BACKGROUND

The critical time to continue or stop breastfeeding is during the first month after hospital discharge. Mothers receive lactation and physical support by fathers and others bottle-feeding human or formula milk to their infants.

PURPOSE

To describe the effect of feeders (mothers, fathers, and others) and different milk feeding on infants' weekly exclusive breastfeeding rates, from birth to 1 month after discharge.

METHODS

This study was a secondary analysis of a descriptive longitudinal study of mothers' (full-term: n = 77; late preterm: n = 39) breastfeeding experience, frequency of feeding, and infant feeding behaviors. Mothers completed a weekly questionnaire of who (mothers, fathers, and others) fed their infants human or formula milk by direct breastfeeding or bottle-feeding.

RESULTS

More than 60% of mothers reported fathers and others bottle-fed their infants. Exclusive breastfeeding rates were significantly higher when only mothers fed their infants at week 1 (P < .001), week 3 (P < .05), and week 4 (P < .05). Exclusive breastfeeding rates were negatively affected across time by bottle-feeding any human or formula milk for all feeders. When fathers bottle-fed their infants at week 1, the relative rates of exclusive breastfeeding at week 4 decreased to 52% (OR = 0.103; 95% CI, 0.26-0.404; P < .0001).

IMPLICATION FOR PRACTICE

Individuals providing early bottle-feeding adversely affect breastfeeding outcomes. Providers need to address maternal and paternal knowledge gaps about early breastfeeding practice.

IMPLICATIONS FOR RESEARCH

Further research is needed to explore clinical standard of care for management of infant weight loss, early supplementation, and support of exclusive breastfeeding outcomes.

Postnatal Unit Experiences Associated With Exclusive Breastfeeding During the Inpatient Stay: A Cross-Sectional Online Survey

BACKGROUND

Efforts to provide accessible and effective infant feeding support are advancing to set up new families to meeting their goals. However, data continue to be limited for understanding how inpatient postpartum support and experiences contribute to exclusive breastfeeding during hospitalization.

RESEARCH AIMS

To explore postnatal unit experiences including skin-to-skin contact, overnight support, rooming-in, responsive clinicians, and understandable communication that correlate with early infant feeding outcomes among a sample of mothers who intended to breastfeed.

METHODS

This was a prospective cross-sectional survey study. Through secure online survey, participants submitted (N = 2,401) responses from November 2016 to May 2017 about their experiences with maternity healthcare and offered thoughts on the postnatal unit environment. Descriptive statistics were used to examine distributions of maternal characteristics, postpartum experience, and birthing facility characteristics.

RESULTS

Exclusive breastfeeding was positively correlated with the following postnatal unit experiences: mother did not ask that her infant be taken out of the postnatal unit room; infant staying in postnatal unit room except for treatment(s); mother got help from clinical staff when needed after pressing the call button; and nurse, midwife, and/or doctor always explained information to mother in ways that they understood.

CONCLUSION

Postnatal unit experiences associated with exclusive breastfeeding during postpartum hospitalization were rooming in; parents who did not ask for their infant to be taken out of the unit room; whether mothers received timely help from clinical staff; and information was explained in a way they could understand.

Why do first-time mothers not intend to breastfeed? --A qualitative exploratory study on the decision-making of non-initiation in Jingzhou, China

Background

Although breastfeeding is one of the top priorities for public health in China, the rate of breastfeeding is still low and a large number of women do not initiate breastfeeding due to various reasons. Hence, this study aimed to understand the decision-making of non-initiation and reveal the underlying reasons in order to protect, support, and promote breastfeeding.

Methods

In-depth, exploratory interviews were carried out with 13 new mothers who did not initiate breastfeeding. The collected data were analyzed by inductive content analysis.

Results

Although mothers generally understood the protective effects of breastfeeding, they believed that formula milk is a good alternative to human milk and even better in some aspects. Five core themes related to non-initiation decision-making emerged: (1) expected breastfeeding stress; (2) maladjustment to the maternal role; (3) concerns about physiological issues; (4) the lack of knowledge about the risks of artificial feeding; (5) belief that it is better not to initiate than to interrupt.

Conclusions

The environment for mothers to breastfeed in China is not supportive enough, and the medical staff and families should be held responsible for the non-initiation of breastfeeding. More professionals are needed to support mothers to solve their problems and breastfeeding education should be further expanded.

Humoral and Cell-Mediated Immune Response in Colostrum from Women Diagnosed Positive for SARS-CoV-2

Objective: To evaluate the immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in colostrum from women who tested positive for the virus. Methods: Between March and September 2020 we obtained bilateral colostrum samples collected on spot cards within 48 hours of delivery from 15 new mothers who had previously tested positive for SARS-CoV-2. Four of 15 women provided liquid colostrum, which was used for validating results obtained from spot cards. Archived bilateral colostrum samples collected from 8 women during 2011-2013 were used as pre-coronavirus disease 2019 (COVID-19) controls. All samples were tested for reactivity to the receptor binding domain (RBD) of the SARS-CoV-2 spike protein using an enzyme-linked immunosorbent assay that measures SARS-CoV-2 RBD-specific IgA, IgG, and IgM and for levels of 10 inflammatory cytokines (interferon-gamma [IFN-γ], tumor necrosis factor-alpha, interleukin [IL]-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-13) using a multiplex electrochemiluminescent sandwich assay. Results: Our validation studies indicate that the levels of SARS-CoV-2-specific antibodies and the associated cytokines measured in liquid colostrum are comparable to levels eluted from spot cards. Bilateral colostrum samples from 73%, 73%, and 33% of the 15 COVID-19 mothers exhibited IgA, IgG, and IgM reactivity to RBD, respectively. In addition, symptomatic COVID-19 mothers had statistically significant elevated levels of 4 of the 10 inflammatory markers (IFN-γ, IL-4, IL-6, and IL-12) compared to asymptomatic COVID-19 mothers. Conclusions: A strong humoral immune response is present in the colostrum of women who were infected with SARS-CoV-2 before delivering. The evolution and duration of the antibody response, as well as dynamics of the cytokine response, remain to be determined. Our results also indicate that future large-scale studies can be conducted with milk easily collected on paper spot cards.

Relationship between Family Social Support and Exclusive Breastfeeding Behavior at Talise Health Center, Indonesia

BACKGROUND: The failure of exclusive breastfeeding has a big impact on the health of a child. Family social support is a factor that plays a major role in the behavior of exclusive breastfeeding. AIM: This study aimed to determine the relationship between social-informational support, emotional, instrumental, and family assessment support on exclusive breastfeeding behavior at Talise Health Center, Palu City. MATERIALS AND METHODS: The research method was quantitative, with a cross-sectional study design. The population was 70 mothers who have babies aged 7–24 months and live in the Talise Health Center working area. The sampling technique was total sampling. Data analysis was the chi square test with a significance level of p <0.05 using SPSS. RESULTS: Univariate analysis showed that the dominant age of the mother was 29–37 years (75.7%), bachelor degree education level (85.7%), multiparous parity status (68.6%), and exclusive breastfeeding status (68.6%). The results showed that there was a significant relationship between social-information support (p = 0.042), instrumental (p = 0.013), emotional (p = 0.038), and assessment (p = 0.020) on the behavior of exclusive breastfeeding. CONCLUSION: Lack of social support from the family, including informational, instrumental, emotional, and assessment, would hinder exclusive breastfeeding behavior and impact on the failure of exclusive breastfeeding.

Relationship between Family Social Support and Exclusive Breastfeeding Behavior at Talise Health Center, Indonesia

BACKGROUND: The failure of exclusive breastfeeding has a big impact on the health of a child. Family social support is a factor that plays a major role in the behavior of exclusive breastfeeding. AIM: This study aimed to determine the relationship between social-informational support, emotional, instrumental, and family assessment support on exclusive breastfeeding behavior at Talise Health Center, Palu City. MATERIALS AND METHODS: The research method was quantitative, with a cross-sectional study design. The population was 70 mothers who have babies aged 7–24 months and live in the Talise Health Center working area. The sampling technique was total sampling. Data analysis was the chi square test with a significance level of p <0.05 using SPSS. RESULTS: Univariate analysis showed that the dominant age of the mother was 29–37 years (75.7%), bachelor degree education level (85.7%), multiparous parity status (68.6%), and exclusive breastfeeding status (68.6%). The results showed that there was a significant relationship between social-information support (p = 0.042), instrumental (p = 0.013), emotional (p = 0.038), and assessment (p = 0.020) on the behavior of exclusive breastfeeding. CONCLUSION: Lack of social support from the family, including informational, instrumental, emotional, and assessment, would hinder exclusive breastfeeding behavior and impact on the failure of exclusive breastfeeding.

A Comprehensive Conceptual Framework to Guide Clinical Practice and Research About Mental Health During the Perinatal Period

Perinatal mood and anxiety disorders (PMADs) affect up to 20% of pregnant and postpartum women and can have negative sequelae for maternal-child health. Nurses with clinical and research roles are on the front line of efforts to assess for and assist with prevention and intervention with PMAD symptoms. Thus, they can play an essential role in enhancing the mental well-being of women in the perinatal period and maternal-child health outcomes. The aim of this article is to assist nurses in this work by outlining the Comprehensive Model of Mental Health during the Perinatal Period, a conceptual framework for considering clinical and research opportunities to enhance perinatal mental health. The framework uses key principles that recognize biopsychoneuroimmunologic mechanisms involved in mental health; the key role that the experience of matrescence ("becoming a mother") plays in mental health and maternal-child health; and the mother-infant dyad as the functional unit during the perinatal period. Examples are provided of how the key principles of this framework might be used to enhance research and clinical practice about PMADs and, ultimately, enhance maternal-child health outcomes.

[Information Resource Network Analysis of Factors Influencing Breastfeeding Planning and Duration]

PURPOSE

This study aimed to identify the modifiable factors affecting breastfeeding planning and duration among healthy mothers and their use of breastfeeding information resources.

METHODS

A cross-sectional survey was conducted in a community setting. Four hundreds participants were recruited at five pediatric clinics and three community health centers located in Paju-si and Goyang-si, Gyeonggi-do, between January and May 2019. Based on the breastfeeding decision-making model, driven by Martens and Young's work, the survey items consisted of demographics, childbirth and breastfeeding characteristics, and breastfeeding information resources. In the analysis, 389 responses were used in the t-test, ANOVA, and logistic regression. Information resource networks were compared before and after childbirth including a subgroup analysis depending on the breastfeeding duration.

RESULTS

The modifiable factors affecting breastfeeding planning and duration were antenatal and postpartum breastfeeding education and the provision of information in the hospital. The frequency of Internet use and websites visited were notable and potentially modifiable factors, which were also observed in the networks showing different relationship patterns according to participant subgroups and times. The childbirth event increased the centralization of the network in the planned group, while the network of the non-planned group was more diffused after childbirth. The network of the short-term breastfeeding group was characterized by a more centralized pattern and the resources of high betweenness centrality than the long-term group.

CONCLUSION

Breastfeeding education is a consistent factor that affects breastfeeding behavior. A well-designed internet-based approach would be an effective nursing intervention to meet the needs of women seeking breastfeeding information and changing their behaviors.

The Baby-Friendly Hospital Initiative (BFHI): An Early Cross-Sectional Analysis of PRAMS Phase 8 Data on Hospital Practices and Breastfeeding Outcomes in Utah and Wyoming

INTRODUCTION

Breastfeeding has immediate and long-term benefits for both maternal and child health. This study examines the association between Baby-Friendly Hospital Initiative (BFHI) experiences and breastfeeding outcomes in the Mountain West region.

METHODS

A cross-sectional (retrospective secondary data analysis) was performed using the 2016 Pregnancy Risk Assessment Monitoring System (PRAMS) data. The participants were derived from a stratified random sample of 2,013 women living in Utah and Wyoming who recently had a live birth and who were surveyed on BFHI practices. The association between BFHI experiences and breastfeeding duration were assessed using crude and adjusted Poisson regression models, controlling for other BHFI experiences and maternal age, pre-pregnancy BMI, household income, smoking, alcohol, delivery method, and number of days spent in the hospital post delivery.

RESULTS

82.4% and 82.3% of women from Utah and Wyoming, respectively, reported breastfeeding for 2 months or longer. After controlling for other BFHI experiences and potential confounders, the one shared BFHI experience that was associated with breastfeeding for 2 months or longer vs less than 2 months was starting breastfeeding in the hospital (adjusted prevalence ratio [aPR]=1.49, 95% CI (1.12, 1.98) in Utah and aPR=2.03, 95% CI (1.13, 3.64) in Wyoming. Among women in Utah and Wyoming, only 5 of 7 BFHI steps were significant for breastfeeding duration in at least one state.

CONCLUSION

There is substantial epidemiological support for health benefits to both mother and infant for exclusive breastfeeding to 6 months and prolonged breastfeeding until at least 1-year. Our findings suggest that women who initiate breastfeeding in the hospital may be more likely to breastfeed for a longer duration.